What are the main health challenges for the decade ahead? The climate crisis, pollution and diet are just some of them.

We all know about COVID – yet what are the main health challenges for the decade ahead? The climate crisis, pollution and diet are just some of them.

Just before COVID-19 infiltrated almost every corner of the planet, the World Health Organization (WHO) released a report in January 2020 on the urgent health challenges for the next decade. Preparing for epidemics was actually sixth on the list, with the report commenting that: “A pandemic of a new, highly infectious, airborne virus – most likely a strain of influenza – to which most people lack immunity is inevitable. It is not a matter of if another pandemic will strike, but when, and when it strikes it will spread fast, potentially threatening millions of lives.”

In September 2019, WHO also published the annual Global Preparedness Monitoring Board report, titled ‘A World At Risk’, which identified ways the world could prepare for a pandemic. The report was introduced in 2018 following the 2014-2016 Ebola epidemic and was based on the premise that while disease has always been part of the human experience, a combination of global trends, including insecurity and extreme weather, had heightened the risk. The report stated that “there is a very real threat of a rapidly moving, highly lethal pandemic of a respiratory pathogen killing 50 to 80 million people and wiping out nearly 5 per cent of the world’s economy. A global pandemic on that scale would be catastrophic, creating widespread havoc, instability and insecurity. The world is not prepared.”

VIRUSES HERE TO STAY

At the time of writing, the reported worldwide death toll from COVID-19 is hovering just over 3.8 million with active cases at 179 million. As new variants of coronavirus continue to be identified, the likelihood that highly infectious diseases will continue to be a pressing health concern for the foreseeable future seems very likely. Stuart Ray, vice chair of medicine for data integrity and analytics at John Hopkins Medicine, says it is the nature of RNA viruses such as the coronavirus to evolve and change gradually. Mutations in viruses – including the coronavirus causing the COVID-19 pandemic – are neither new nor unexpected, which is why doctors recommend that you get a new flu vaccine every year.

Ray says, “There is new evidence from laboratory studies that some immune responses driven by current vaccines could be less effective against some of the new strains.” However, he adds, the vaccine is important because “the immune response involves many components, and a reduction in one does not mean that the vaccines will not offer protection”.

Ray recommends that people who have received the vaccines should watch for changes in guidance from the health authorities and continue with coronavirus safety precautions to reduce the risk of infection, such as mask wearing, physical distancing and hand hygiene. So while the vaccine will continue to be an important part of the future of healthcare, so will our new routines of mask wearing, physical distancing and hand hygiene to limit the spread of viruses.

A report published in The Lancet entitled ‘Living with the COVID-19 pandemic’ looked at the most effective responses by countries in their attempt to suppress transmission. Rapid detection is at the top of the list, followed by isolating and managing people infected, investigating outbreaks, short-term closures and protection of healthcare workers. While countries such as New Zealand and Australia are doing well in keeping numbers low, what’s proving most difficult is how best to resume international travel.

To date, there is yet to be an optimal way to prevent importation of SARS-CoV-2, no matter how rigorously quarantine and testing are applied, because of the range in the SARS

“THE IMMUNE RESPONSE INVOLVES MANY COMPONENTS.”

STUART RAY

CoV-2 incubation period (2-14 days), the spectrum of disease (with subclinical and mild illness in many infected individuals), the fact that many travellers return to households with others who are not quarantined, and the number of days after infection to the time when polymerase chain reaction testing becomes positive.

CLIMATE CRISIS

So what did WHO predict would be the main health focus for the next decade before COVID-19 took over? How the climate crisis is affecting health, specifically air pollution, which is killing an estimated 7 million people every year, in addition to the people who are impacted by the extreme weather events that exacerbate malnutrition. The WHO report states that “the same emissions that cause global warming are responsible for more than one-quarter of deaths from heart attack, stroke, lung cancer and chronic respiratory disease”. While New Zealand and Australia have a high standard of air quality compared to many countries around the world, ambient air pollution was estimated to contribute to 1,277 premature deaths in 2016 in New Zealand, according to the Ministry for the Environment and Statistics, and an annual 4880 premature deaths in Australia according to a 2020 air quality report.

The pollution is caused by the tiny airborne particles (particulate matter) produced from combustion processes such as bushfires, wood heaters, vehicle emissions and coal-fired power stations. These can enter the lungs, where the smallest-sized particles can then translocate into the bloodstream, causing inflammation and damage to other organs. While government agencies are working to reduce air pollution, it is an uphill battle with a growing population, growing urbanisation and increased transport and energy demands.

In New Zealand, the large share of renewable energy sources makes it one of the most sustainable countries in terms of energy generation; however, 60 per cent of energy still comes from fossil fuels. Meanwhile, the Australian government predicts that by 2030, road and rail freight are expected to grow by 80 and 90 per cent respectively, and by 2061, it estimates 74 per cent of Australians, compared to 66 per cent in 2012, are expected to live in a capital city.

The WHO says global tobacco use is down 33 per cent since 2000.

It’s not all big business causing the air pollution. According to the Climate Council, cars are responsible for roughly half of Australia’s greenhouse gas pollution. In New Zealand, around a third of New Zealand’s electricity demand is from households and over a third is from industrial sectors.

So what can we do on a personal level to minimise air pollution? Invest in solar power, buy local, turn off electricals when you’re not using them, create green spaces at home or in the community, recycle where possible, and limit the use of a car as much as you can.

FOOD FOR THOUGHT

Also top of WHO’s watchlist of urgent health challenges for the next decade are unhealthy diets and unsafe food, which are responsible for almost one-third of today’s global disease burden. A large-scale study with collaborators from all over the world looked at the health effects of dietary risks in 195 countries from 1990-2017. The ‘Global Burden of Disease’ study determined that each year worldwide, 11 million deaths and 255 million disability-adjusted life-years were attributable to dietary risk factors. High intake of sodium was the worst offender, responsible for 3 million deaths, followed by low intake of whole grains, then low intake of fruits. Diets low in nuts and seeds, low in vegetables, and low in omega-3 fatty acids were also found to be prevalent.

It’s certainly not new or groundbreaking, but research keeps showing the healthiest food choices are the minimally processed foods such as vegetables and fruits, wholegrains, healthy fats and healthy sources of protein, while limiting the intake of sugar and salt.